Rheumatoid Arthritis ☺️

Question 1

Epidemiology
Genetics
Conditions that often accompany RA

Answer 1

High in native Americans
Females
Peaks at 30-50s

HLA DR4

Female prevalence

Often accompanied by
-vasculitis, Sjogrens, Raynaulds

Question 2

Pathophysiology

Answer 2

Innate and adaptive immune system => chronic progressive immune response

Synovial inflammation => joint damage

Question 3

Presentation

• initial
• progression

Answer 3

Swollen, painful symmetrical PIP
-DIP sparing
Morning stiffness worse in morning
Insidious onset over months
No enthesitis

Progression

• Larger joint involvement
• Swan neck fingers, hitchhiker thumbs
• rheumatoid nodules of cholesterol
• telescoping fingers
• atlanto-axial subluxation => cervical SC compression

Question 4

Respiratory manifestations of RA

• as a result of RA
• as a result of drug management of RA

Answer 4

Pleural effusion
ILD
Pleurisy
Pulmonary nodules

Methotrexate pneumonitis
Infection secondary to immunosuppression

Question 5

Complications of RA

Answer 5

Resp

• IDL
• pleural effusion
• pulmonary nodules
• methotrexate pneumonitis

Eyes - inflammation of different areas

Due to increased inflammation

• osteoporosis
• IHD

Due to medication - IC

Impact of condition - depression

Question 6

Initial investigations

Diagnostic criteria

Answer 6

Autoantibodies

• RF - more sensitive
• CCP - more specific

Xray hands and feet

• loss of joint space
• erosions
• soft tissue swelling
• soft bones (osteopenia)

Clinical diagnosis more important than criteria

Question 7

Management

• initial
• SE
• monitoring response to treatment
• flares
• use of biologics

Answer 7

Initial - methotrexate + CS (alts: sulfasalazine, HCQ)
Flares => CS

Monitor response

• CRP and DAS28
• if using methotrexate => monitor FBC, LFT
• SE: myelosupression, cirrhosis, pneumonitis

TNF inh - inadequate response to 2+ DMARDs

• infliximab, adalimumab, etanercept
• CD20 rituximab